Pharmacy-Based Approach to Improving Heart Failure Medication Use by Older Adults with Limited Health Literacy: Learning from Interdisciplinary Experience.
Pharmacy-Based Approach to Improving Heart Failure Medication Use by Older Adults with Limited Health Literacy: Learning from Interdisciplinary Experience.
复制标题
基于药房的方法来改善健康素养有限的老年人心力衰竭药物的使用：从跨学科经验中学习。
DOI：
10.1007/s40266-018-0586-7
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发表时间：
2018
期刊：
影响因子：
2.8
通讯作者：
Murray,MichaelD
中科院分区：
文献类型：
--
作者：
Bonderski,Veronica;Morrow,DanielG;Chin,Jessie;Murray,MichaelD
心力衰竭是一种慢性疾病，需要仔细注意自我护理。患者必须遵循饮食和药物使用说明，以防止或延缓功能状态、生活质量和昂贵护理的下降。然而，心力衰竭患者对重要护理程序的知识、认知和健康素养存在相当大的异质性，这预示着实施自我护理的能力。我们由具有健康素养专业知识的认知科学家、药剂师和医生组成的跨学科团队花了18年时间设计和测试方案和材料，以帮助动态心力衰竭患者进行护理。我们的方法是理论驱动的，也是问题驱动的，在我们的过程知识模型的指导下，因为它与患有心力衰竭或高血压的老年门诊患者的自我护理有关。我们利用从这个模型中学到的东西来开发基于药房的方案，并定制患者指导材料，这是随机临床试验的中心组成部分。我们的结果显示，患者对心血管药物的依从性提高了，健康结果和患者满意度也提高了，而且直接降低了成本。这些结果表明，我们的跨学科努力在制定战略以改善教学和沟通方面的价值，并关注健康素养，这是药房和其他门诊医疗服务的核心组成部分。我们相信，关注健康素养和药物使用将改善患有心力衰竭和其他复杂慢性病的老年患者的健康结果。
Heart failure is a chronic disease requiring careful attention to self-care. Patients must follow instructions for diet and medication use to prevent or delay a decline in functional status, quality of life, and expensive care. However, there is considerable heterogeneity in heart failure patients’ knowledge of important care routines, their cognition, and their health literacy, which predict the ability to implement self-care. Our interdisciplinary team of cognitive scientists with health literacy expertise, pharmacists, and physicians spent 18 years designing and testing protocols and materials to assist ambulatory heart failure patients with their care. Our approach is theory- as well as problem-driven, guided by our process-knowledge model of health literacy as it relates to self-care among older adult outpatients with either heart failure or hypertension. We used what we had learned from this model to develop a pharmacy-based protocol and tailored patient instruction materials that were the central component of a randomized clinical trial. Our results showed improved adherence to cardiovascular medications, improved health outcomes and patient satisfaction, and direct cost reductions. These results demonstrate the value of our interdisciplinary efforts for developing strategies to improve instruction and communication with attention to health literacy, which are core components of pharmacy and other ambulatory healthcare services. We believe attention to health literacy with medication use will result in improved health outcomes for older adult patients with heart failure and other complex chronic diseases.